Claim CLM-2024-8650
Patient
- Name
- Umberto Conti
- Date of birth
- 1995-03-20
- Patient id
- H021
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 1 (denial date, no service date on file)
- Procedure
- 70553, Brain MRI with Contrast
- Diagnosis code
- G43.909
- Billed amount
- $4,800
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Apr 1
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.